Efficacy of ranibizumab combined with laser photocoagulation on retinopathy of prematurity and the TGF-β/Smad4 pathway mechanisms

Wei Tanwei; Liu Zhiping; Peng Jianjun

doi:10.3969/j.issn.1672-8157.2025.04.025

Abstract：Objective To explore the effect of ranibizumab combined with laser photocoagulation on treatment of retinopathy of prematurity(ROP)and AngⅡ-mediated transforming growth factor-β(TGF-β)/smad homolog 4(Smad4)pathway mechanisms.Methods A total of 92 children who were diagnosed with ROP and admitted to the Ophthalmology Department of Wuhan Puren Hospital from February 2022 to February 2024 were enrolled as the research subjects.According to the general information matching principles,the children were categorized into the combination group(n=46 eyes)and the control group(n=46 eyes).The combination group received intravitreal injection of ranibizumab in conjunction with 810 nm laser photocoagulation,whereas the control group only received laser treatment.The parameters such as visual acuity,visual field,fundus structure,occurrence of adverse events,and the TGF-β/Smad4 signaling pathway mechanisms were evaluated.Results There were significant interactions of the visual acuity(F=6.82,P=0.002),visual field(F=8.15,P=0.001),retinal vascularization time(F=18.35,P<0.05),and ridge regression time(F=5.83,P<0.05)of the two groups before and after treatment.The visual acuity of both groups was higher after the treatment for 1 and 3 months than before the treatment(all P<0.01).The visual acuity of the combination group((0.35±0.12),(0.45±0.15))was higher than that of the control group((0.25±0.10),(0.32±0.11))(both P<0.01).The visual fields of both groups were higher after the treat-ment for 1 and 3 months than before the treatment(all P<0.01).The visual fields of the combination group were higher than those of the control group after the treatment for 1 and 3 months((80.34±12.67)°vs(70.45±11.89)°,(85.67±13.25)°vs(75.23±12.45)°)(both P<0.01).The improvement in fundus structure of the combined group was better than that of the control group after the treatment for 1 and 3 months(all P<0.05).Regarding the TGF-β/Smad4 pathway,the levels of TGF-β mRNA and Smad4 mRNA in both groups were lower after the treatment than before the treatment(both P<0.05),and the levels of the above indexes of the combination group were lower than those of the control group(both P<0.05).The incidence rates of adverse reactions were relatively low in the two groups,and there were no significant differences between the two groups(χ2=1.046,P=0.307).The cell experiment results showed that compared with the control group,different concentrations of AngⅡcould promote the increase of TGF-β mRNA and Smad4 mRNA levels in PBMCs of ROP children(both P<0.05),and the addition of ranibizumab could effectively reduce the increase of TGF-β mRNA and Smad4 mRNA levels caused by AngⅡ(P<0.05).Conclusion The combination of ranibizumab and laser treat-ment for ROP demonstrates remarkable advantages in enhancing visual acuity,enlarging visual fields,improving fundus structure,and modulating and inhibiting the activity of the TGF-β/Smad4 pathway.